On March 13, the Yale School of Medicine sent its second medical relief team to Haiti. The focus this time was less on emergency trauma such as crush injuries, and more on the long-term medical problems that continue to plague Haiti in the aftermath of the earthquake.
The team worked at Hopital de l'Universite d'Etat d'Haiti, a 700-bed facility that is part of University General Hospital in Port-au-Prince.
The group was led by Dr. Anthony Tomassoni of the Department of Emergency Medicine and consisted of five physicians and five nurses from Yale-New Haven Hospital. The former group included, in addition to Tomassoni, Dr. John S. Giuliano, Dr. Felix Y. Lui, Dr. Dirk C. Johnson and Dr. Gary V. Desir; the latter included Susan B. Reynolds, Alicia A. Purzycki, Kathryn E. Holley, Carrie L. Britton and Anne Stevens.
The following are edited excerpts from e-mail updates sent by Tomassoni and reflections from team members.
Tomassoni's e-mail updates
March 16: All hot, tired, sweaty but safe. ... We brought meds and support. The nurses are stars — working hard with patients and families under unsanitary conditions with limited and unfamiliar equipment. Will go off shift at 7 a.m. to try to clean up and sleep. Night shift is the longest one.
March 17: Have watched an interesting transformation among the staff who have not experienced similar field work before. It was an almost instantaneous adaptation to the surreal conditions, massive and unmeetable needs, and limited resources. ...
March 18: The ER is having a crazy night — throngs of patients clamoring to be seen. Lui, Johnson did an emergency c-section for presumed eclamptic woman who arrested. Infant was about 20 weeks and too young for effective resuscitation. John has had a busy time in pediatrics. He has resuscitated several young ones and was standing by to assist with this code. ... Gary has helped with many medicine patients, but especially with several cases of acute and chronic renal failure. He will have teaching rounds tomorrow.
The local staff is beginning to warm up to us, and has begun asking us to share work with them. I have hopes that this will provide continuity of care.
March 22: As with other disasters, the many layered contrasts in Haiti "after that which happened" are striking. Many are reluctant to name the event, seemingly with a sense that speaking the word "earthquake" will reinforce the already massive losses.
Helicopters flying over tent cities and hastily erected shanties without access to running water or adequate sanitation, improvised and adapted medical care facilities where ultrasound machines are being used on patients who must void in improvised chamber pots in buildings without bathrooms, places where the contents of those pots are regularly tossed in shallow ditches immediately outside the door; patients receiving advanced medications and procedures while they lie on crude cots where their family members sleep underneath on the floor, the lucky ones on cardboard mats. During rains, displaced rats and roaches seem to have multiplied as they leave the safety of their flooded nests for exposed streets and floors, scurrying between sleepers. Cell phones are ubiquitous; the roofs and courtyards of many structures which remain standing hold recently added satellite dishes connected to amplifiers and routers that keep individuals and families, residents and relief workers connected. ...
Brownouts, blackouts and long periods during the day without running water remain common during our visit. A small aftershock occurred on the final night of our work. ... Malaria and other tropical disease exposures are commonplace, especially for the sizable population that remains homeless without tents or other shelter. Many have diarrhea from contaminated water and typhus, and bathroom facilities are scarce. Many void or defecate in the streets. ... People are without access to medical care and medications needed to manage chronic diseases like diabetes, hypertension and infectious diseases. ... Post-partum cardiomyopathy and strokes resulting from uncontrolled hypertension are commonplace. It's difficult to stop long enough to capture thoughts in writing amidst all this need ...
Team members' reflections
Dr. Felix Y. Lui: My first impression is shock at the poverty and the conditions when I first arrived. I remember thinking that decent medical care can't possibly be delivered. But then you meet the wonderful people here and you learn that compassionate care can be given in any condition. ... The faces become people and personalities, and then simply your patients. ... You learn to be more creative and to do what you can, but always wish that there was something more you could do.
Dr. Dirk C. Johnson: ... Each night there seem to be more local doctors, nurses coming back to work. Despite whatever personal tragedy they have endured they show up to work and care for their countrymen. They may not have received a paycheck in months but they keep showing up. This is the spirit that will lead to recovery.
Susan B. Reynolds, R.N.: The conditions are desperate yet you would never know it by looking at the faces of patients and families. They light up every time we walk into the room with a "Bon Soir." They just want to be cared about and treated well. They never complain that they are sleeping on the floor (that the rat just ran across) on a piece of cardboard. They look out for each other unbelievably. They don't just care for their own loved ones but also for the neighbors in the bed next door who may not have any family. Some are discharged but do not leave. You know they probably have nowhere to go. A smile and soft touch go as far as the antibiotic they need desperately in order to heal.
Carrie L. Britton, R.N.: ... Through the rubble, the heat, the chaos, the wreckage there are beautiful, smiling, positive, hopeful people. ... The Haitian people are so appreciative and grateful for even a smile and a hand held for a moment. They are stronger as individuals, families and as a country than I could ever imagine that I could be as a person. ...
Dr. John S. Giuliano: After living and working in Haiti for a week I've realized that the state of health care and the living conditions here are much worse than conveyed on television. ... Supplies, diagnostic tests and patient education are resources in short supply, however the residents work tirelessly to provide the best health care possible under the circumstances. I am honored to work alongside of them, and I believe these young physicians have the ability to get Haiti back on its feet. ...
Anne Stevens, R.N.: ... Doctors, nurses and families work to save the lives of patients. Unfortunately, more are lost than saved. We are accustomed to telling families "we did all we could." Here we would be telling a lie. Instead, we tell them "they are better off." The families agree. For the first time I pulled a sheet over a man's still face. For the first time, I've been forced to settle for less than my best. And for the first time I felt absolutely helpless. How is it fair that reusing IV bags and tubing is a standard of care? Since when is it acceptable to lay in a bed using a soiled old towel as a sheet? Why should a wife have to bag ventilate her intubated husband by herself? How long will it be before these people receive what they deserve? ...